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Comparison Between Endoscopic Vacuum Therapy and Conventional Treatment for Leakage After Rectal Resection. | LitMetric

Comparison Between Endoscopic Vacuum Therapy and Conventional Treatment for Leakage After Rectal Resection.

World J Surg

Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.

Published: April 2020

AI Article Synopsis

  • Anastomotic leakage after rectal resection is a serious complication needing prompt management, with endoscopic vacuum therapy (EVT) emerging as a popular treatment option in Germany and beyond.
  • A study comparing 21 patients treated with EVT to 41 patients undergoing conventional treatment found EVT had a significantly higher success rate (95.2% vs. 65.9%) and better preservation of intestinal continuity (86.7% vs. 37.5%).
  • Although conventional treatment led to a slightly shorter hospital stay (31.1 days vs. 42.2 days), both treatments appeared similar in overall treatment duration and time to close a diverting stoma.

Article Abstract

Background: Anastomotic leakage after rectal resection represents a severe complication for the patient and requires an early and appropriate management. Endoscopic vacuum therapy (EVT) has become the treatment of choice for anastomotic leakage after rectal resection in several institutions in Germany, and commercially available systems are currently distributed in approximately 30 countries worldwide. However, there is no evidence that EVT is superior to any other treatment for anastomotic leakage after rectal resection.

Methods: Twenty-one patients treated with EVT for anastomotic leakage after rectal resection were retrospectively compared to a historical cohort of 41 patients that received conventional treatment. Primary endpoints were death, treatment success and long-term preservation of intestinal continuity. Secondary endpoints were length of hospital stay and duration of treatment.

Results: There was no difference in mortality (p = 0.624). The intention-to-treat analysis showed a significantly higher success rate of EVT compared to conventional treatment (95.2% vs. 65.9%, p = 0.011). EVT was associated with preservation of intestinal continuity in a significant higher percentage of patients than patients undergoing conventional treatment (86.7% vs. 37.5%, p = 0.001). Conventional treatment tended to a shorter length of hospital stay (31.1 vs. 42.2 days, p = 0.066) but with no difference in overall duration of treatment. Time until closing of a diverting stoma did not differ between groups (10.2 months in the EVT group vs. 9.4 months in the conventional treatment group, p = 0.721).

Conclusion: According to this retrospective study, conventional therapy and EVT are both options for the treatment of anastomotic leakage after rectal resection. EVT might be more effective in terms of definite healing and preservation of intestinal continuity.

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Source
http://dx.doi.org/10.1007/s00268-019-05349-5DOI Listing

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